Background Time-resolved rotational angiography (t-RA) enables interventionists to better comprehend complex arteriovenous malformations (AVMs), thereby facilitating endovascular treatment. However, its use in evaluating hemodynamic changes has rarely been explored.
Objective This study uses t-RA to estimate intravascular flow in patients with AVM to compare this with flow in the normal population.
Methods Patients with available t-RA scans were prospectively categorized into one of three groups: hemorrhagic AVM, non-hemorrhagic AVM and control. Pulsatile time–density curves (TDCs) for C1, C6 and VOIMCA were used for amplitude and velocity estimation. C1 was at the cervical internal carotid artery (ICA), 2–3 cm below the carotid canal, C6 was at the paraclinoid segment of the ICA, and VOIMCA was at the junction of the first and second segment of the middle cerebral artery (MCA). A waveform amplitude ratio was defined as (peak − trough)/trough contrast intensity. VICA was defined as the distance between C6 and C1 divided by the time required for the wave to pass, and correspondingly, the average velocity of MCA (VMCA) was defined as the distance between C6 and VOIMCA divided by the duration for the same peak to travel from C6 and VOIMCA, AVM volume was estimated by MR angiography.
Results Amplitude ratios AC1 and AC6, and average flow velocities VICA and VMCA were significantly larger in the non-hemorrhagic group than in the control group, while the hemorrhagic AVM group was not significantly different from the controls. VICA and VMCA showed moderate to good correlations with AVM volume (r=0.51 and 0.73, respectively). VMCA (33.0±9.1) was significantly lower than VICA (41.3±13.2) in the control group, but not in the two AVM groups.
Conclusion TDC waveform propagation derived from t-RA can quantify hemodynamic differences between AVM and the control group. t-RA provides both real-time anatomic and hemodynamic evaluation, and can thus potentially improve the interventional workflow.
- arteriovenous malformation
- blood velocity
- time density curve
- time-resolved rotational angiograph
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Contributors Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work: CJL,HCY, WYG, CCW, and WFC. Drafting the work or revising it critically for important intellectual content: CJL, ACC, SCH, and KKC. Final approval of the version to be published: CJL, HMW, CBL, WYG, JSH, CSFW. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: CJL, and HCY. Administrative/technical/material support: all authors.
Funding This work was supported by the Taipei Veterans General Hospital (grant No V1062C2058) and Siemens Healthcare (grant No T1100200).
Competing interests None declared.
Ethics approval Institutional review board, Taipei Veterans Hospital.
Provenance and peer review Not commissioned; externally peer reviewed.